背景:灾难对人类健康的威胁越来越大,但是我们对它们对医疗服务的影响知之甚少,特别是在低收入和中等收入地区。“弹性医院”越来越被认为是灾害管理的基石。虽然存在各种医院弹性框架,他们从灾难前的考虑中脱颖而出,并且不包含来自灾后环境的证据。
目的:本文调查了尼泊尔某三级医院发生的大规模突发性灾难的影响,并探索了其弹性机制。
方法:这是一个深入的案例研究,结合了常规生成的医院记录的定量数据和与医院工作人员进行半结构化访谈的定性数据。我们使用了先进的统计方法和混合归纳和演绎编码来分析数据。
结果:大多数入院的地震受害者需要手术干预和长期住院,医院相当紧张。六个星期,平均每日入院人数下降。在此期间,与伤害相关的入院比例特别高,与基线相比,此类入院时间特别长。由于其他条件的录取相对减少且较短。我们发现医院的复原力高度依赖于新出现的适应,除了先前存在的灾难计划。员工的个人韧性也发挥了重要作用,受到安全感的影响,有意义,和归属。
结论:医院应准备资源并为其已知的灾害风险做好计划,但也应该允许对新兴市场的创新适应有一定的灵活性,不可预见的挑战。医院工作人员面临的挑战不应受到破坏,解决这些问题将提高医院的适应能力。
BACKGROUND: Disasters are an increasing threat to human health, but we know little about their impact on health services, particularly in low and middle-income settings. \'Resilient hospitals\' have been increasingly recognized as a cornerstone of disaster management. While various frameworks of hospital resilience exist, they emerged from pre-disaster considerations, and do not incorporate evidence from post-disaster settings.
OBJECTIVE: This dissertation investigated the impact of a large-scale sudden onset disaster in a tertiary hospital in Nepal, and explored its resilience mechanisms.
METHODS: This consists of an in-depth
case-study combining quantitative data from routinely generated hospital records and qualitative data from semi-structured interviews with hospital staff. We used both advanced statistical methods and mixed inductive and deductive coding to analyze the data.
RESULTS: Most of the admitted earthquake victims required surgical interventions and long hospitalizations, considerably straining the hospital. For six weeks, the average number of daily admissions decreased. During this period, the share of injury-related admissions was particularly high, and such admissions were particularly long compared to the baseline. Admissions due to other conditions relatively decreased and were shorter. We found that the hospital\'s resilience was highly dependent on emerging adaptations, in addition to the pre-existing disaster plan. Individual resilience of staff also played a major role, and was influenced by senses of safety, meaningfulness, and belonging.
CONCLUSIONS: Hospitals should prepare resources and plan for their known disaster risks, but should also allow for a certain flexibility to innovative adaptions to emerging, unforeseen challenges. Challenges faced by hospital workers should not be undermined, and addressing them will increase hospital resilience.